Impact of the Pneumococcal Conjugate Vaccines (PCV) on the burden of invasive pneumococcal disease (IPD) in Ireland Data source: National Pneumococcal Typing Project ( Data based on invasive Streptococcus pneumoniae isolates submitted for serotyping) Date updated: 18 th March 2015 HSE-Health Protection Surveillance Centre (HPSC)Tel: Middle Gardiner Street, Dublin 1, Ireland.Fax:

Background  IPD is a notifiable disease since January 2004  Clinicians and laboratories are legally obliged to notify all cases to the relevant Department of Public Health  IPD Typing Project commenced in April 2007 and has been instrumental in:  Determining the serotype distribution of IPD isolates prior to the introduction of PCV7 to the infant immunisation schedule  Monitoring the impact of the vaccine on the burden of IPD and on the serotype distribution of isolates  PCV7 vaccine was introduced in September 2008  To the routine infant immunisation schedule at 2, 6 and 12 months  Catch-up for children < 2 years of age (born 02/09/ /06/2008)  PCV13 was introduced in December 2010  To the routine infant immunisation schedule at 2, 6 and 12 months for children born in or after October 2010

Serotypes covered by the Pneumococcal Conjugate Vaccines (PCV) used in Ireland since A6B7F9V1418C19A19F23F PCV7 PCV13 PCV7 and PCV13 serotypes are highlighted in red and blue, respectively Where the term “PCV13-7” is presented in later slides, this relates to the six additional 6 serotypes covered by PCV13 i.e. serotypes 1, 3, 5, 6A, 7F and 19A

Summary of Results Comparing data from Jan-Dec 2014 with same period in 2008, the main findings based on laboratory data from the National Pneumococcal Typing Project are:  IPD in Ireland declined by 19% overall  The most dramatic decline was in children <2 years of age 100% decline due to PCV7 serotypes 78% decline due to PCV13-7 serotypes 77% decline due to all serotypes  There was a 86% decrease in IPD due to PCV7 serotypes in ≥2 year olds  Overall decrease in IPD in ≥2 year olds, but: increases were seen 5 % increase due to PCV13-7 serotypes 79% increase due to non-PCV13 serotypes  Predominant serotypes in Jan – Dec 2014 were: 7F, 15A, 22F, 3, 8 and 19A

Impact of PCV on the burden of IPD caused by PCV7 vaccine serotypes in <2 year olds 100% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by PCV7 vaccine serotypes in ≥2 year olds 86% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by PCV7 vaccine serotypes in all age groups 89% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by PCV13-7 vaccine serotypes in <2 year olds 78% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by PCV13-7 vaccine serotypes in ≥2 year olds 5% increase in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by PCV13-7 vaccine serotypes in all age groups 4% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by non-PCV13 vaccine serotypes in <2 year olds 50% increase in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by non-PCV13 vaccine serotypes in ≥2 year olds 79% increase in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by non-PCV13 vaccine serotypes in all age groups 77% increase in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by all serotypes in <2 year olds 77% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by all serotypes in ≥2 year olds 10% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Impact of PCV on the burden of IPD caused by all serotypes in all age groups 19% reduction in IPD cases, comparing Jan-Dec 2014 with the same period in 2008 Data source: IPD Typing Project

Cumulative number of IPD isolates between January – December 2008 and 2014 and percentage changed in burden of IPD since introducing PCV in Ireland Data Source: National Typing Project PCV7 serotypes: 4, 6B, 9V, 14, 18C, 19F and 23F; PCV13-7 serotypes: 1, 3, 5, 6A, 7F, 19A Non-PCV13 serotypes: All serotypes excluding the 13 serotypes (listed above) in PCV13

Distribution of the S. pneumoniae serotypes in Ireland by age group in Jan - Dec 2014 * Denotes serotypes included in PCV7 *^ Denotes additional serotypes included in PCV13 Data source: IPD Typing Project

Activities key to the surveillance of IPD in Ireland  Notifications: Clinicians and laboratories should notify all cases of IPD to the relevant Department of Public Health and data are inputted to the national Computerised Infectious Diseases reporting (CIDR) system for notifiable infectious diseases.  Typing: Laboratories should submit all invasive S. pneumoniae isolates to RCSI/Beaumont for typing.  Enhanced surveillance: Departments of Public Health should perform enhanced surveillance on cases of IPD notified in children <15 years of age and enter these data on CIDR.  Antimicrobial resistance: Laboratories should report data on antimicrobial resistance profiles of invasive S. pneumoniae isolates (from blood and CSF) to the European Antimicrobial Resistance Surveillance System Network(EARS-Net) at HPSC.

Laboratories: Submission of isolates for typing For details regarding the submission of invasive Streptococcus pneumoniae isolates for typing, please contact: Dr. Mary Corcoran Tel.:

Departments of Public Health: IPD surveillance  IPD enhanced surveillance form is available at: Z/VaccinePreventable/PneumococcalDisease/SurveillanceForms / Z/VaccinePreventable/PneumococcalDisease/SurveillanceForms /  Protocol for the enhanced surveillance of IPD is available at: Z/VaccinePreventable/PneumococcalDisease/InformationforHealthProfessionals / Z/VaccinePreventable/PneumococcalDisease/InformationforHealthProfessionals /

Further Reading For further details on the surveillance and epidemiology of IPD in Ireland, please see:  Biannual Reports on invasive Streptococcus pneumoniae infection; available at Z/VaccinePreventable/PneumococcalDisease/Publications/QuarterlyReportsonInvasivePneu mococcalDisease/  Annual Reports on invasive Streptococcus pneumoniae infection; available at Z/VaccinePreventable/PneumococcalDisease/Publications/AnnualReportsonInvasivePneumo coccalDisease/File,14720,en.pdf  Articles published in Epi-Insight; available at Z/VaccinePreventable/PneumococcalDisease/Publications/Articles/ Z/VaccinePreventable/PneumococcalDisease/Publications/Articles/  Posters and Presentations, available at Z/VaccinePreventable/PneumococcalDisease/PostersPresentations/ Z/VaccinePreventable/PneumococcalDisease/PostersPresentations/  Quarterly and Annual EARSS Reports; available at Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystem EARSS/EARSSSurveillanceReports/ Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystem EARSS/EARSSSurveillanceReports/

IPD National Typing Project Team Dr Imelda Vickers 1, Dr Mary Corcoran 1, Prof Hilary Humphreys 2, Dr Darina O’Flanagan 3, Dr Suzanne Cotter 3, Dr Robert Cunney 1, 3, Mr Stephen Murchan 3 and Dr Margaret Fitzgerald 3, Jolita Mereckiene 3 1 Epidemiology and Molecular Biology Unit, Children’s University Hospital, Temple Street 2 Education and Research Centre, Royal College of Surgeons in Ireland and Beaumont Hospital 3 Health Protection Surveillance Centre (HPSC), Dublin.

Acknowledgements The Pneumococcal Typing Project Team wish to thank Mary Corcoran, Martha McElligott and Imelda Vickers who carried out the serotyping, all the laboratories who have participated in the project to date, your support is very much appreciated. Thanks to all the health care professionals involved in the surveillance of invasive pneumococcal disease in Ireland.